Innovations in paediatric urology at the EAU

13 April 2014

Experts in Paediatric Urology presented the most current research and innovations in the field during Thematic Session 5. All those interested in the field were updated on genetic aspects, the status of minimally invasive treatment in children, modern stone treatment options and the vesicoureteral reflux information from the latest EAU Guidelines on Paediatric Urology.

One of the key messages of the session was that careful consideration should be given to the particulars of each case, looking at how patients respond to treatment in a focussed manner. Dr. Agnetta Nordenskjold (Stockholm, SE), a key expert in the genetic aspects of congenital urological malformations, opened the session. According to her, it is crucial to understand that malformations generally involve a combination of genetic and environmental factors. This knowledge will lead to better treatments and outcomes. She concluded by saying that these different groups of patients have different follow-up needs, and that “the exact molecular mechanism not only affects the treatment path, but also answers pressing questions” about specific treatments.

Up next, Mr. Ramnath Subramaniam (Leeds, GB) began by noting that the application of the minimally invasive approach in children lagged behind because of the inability of practitioners to demonstrate a measurable difference in postoperative recovery time, and because the open approach seems to be equally effective. However, for him this debate is also a question of resources: not all care centres and hospitals have the same availability. Nevertheless:“robotic surgery is almost certainly going to replace other procedures when the cost goes down”, and when training in these technologies becomes widely available. Again, he also stressed the case-by-case basis of treatment, and that it is important to justify initial and running costs.

Dr. Ezekiel Landau (Jerusalem, IL) presented a study on the new instruments and scope for the treatment of stones in children and infants. For him, the miniaturisation and sophistication of the scopes has helped make open surgery for stones in paediatric patients obsolete, and that depending on the case, SWL, URS, and PCNL are better treatment options for renal stones.

Prof. Serdar Tekgül (Ankara, TR) closed the session by presenting the overview of the Guidelines on vesicoureteral reflux. He stressed in his presentation that a risk analysis should be done for each patient, trying to minimise the diagnostic and interventional morbidity and costs wherever possible. To bring home the message that served as underlying theme of the session, Prof. Tekgül emphasised that “there is no single recipe that can be applied to all patients”.